Fluoride-induced apoptosis in non-skeletal tissues of experimental animals: A systematic review and meta-analysis.

Different studies have suggested that fluoride can induce apoptosis in non-skeletal tissues, however, evidence from these experimental studies is still controversial. This meta-analysis aims to clarify the mechanism of fluoride-induced apoptosis in non-skeletal tissues of experimental animals. Primary studies which measured apoptosis were identified through exhaustive database searching in PubMed, Embase, Web of Science Core Collection, Scopus, and references of included studies. A random effects model with standardized mean difference (SMD) was used for meta-analyses. The heterogeneity of the studies was evaluated using Higgin's I2 statistics. The risk of bias and publication bias were assessed using the SYRCLE's risk of bias tool and Egger's test, respectively. There was an increase in total apoptotic cells, and the expression of Bax, Bax/Bcl-2 ratio, caspase-3, caspase-8, caspase-9, Cyt c, and p53, and a decrease in the expression of Bcl-2 in the fluoride-treated groups as compared to the control groups. However, there was no evidence of a difference in the expression of APAF-1 in the two groups. The subgroup analysis highlighted the role of the intervention period in modification of the apoptotic effect of fluoride and that the susceptibility and tolerance of different animal species and tissues vary. Meta-regression analysis indicated that the studies' effect size for total apoptotic cells was influenced by animal species and that of Bax by the sample source. The results of this meta-analysis revealed that fluoride causes apoptosis by up-regulating caspase-3, -8, and -9, Cyt c, p53, Bax, and down-regulating Bcl-2 with a concomitant up-regulation of the Bax/Bcl-2 ratio.

Women's autonomy and modern contraceptive use in Ghana: a secondary analysis of data from the 2014 Ghana Demographic and Health Survey.

OBJECTIVE: Women's empowerment and autonomy have been proven to promote women's use of modern contraceptives. This study examined women's autonomy as a potential factor for modern contraceptive use among Ghanaian women in a union. METHOD: We conducted a secondary analysis of data from the 2014 Ghana Demographic and Health Survey. The main outcome measure was current modern contraceptive use from women's self-report. Three composite indices were used to assess women's autonomy: household decision-making, attitudes towards wife-beating, and property ownership. RESULTS: A total of 4772 non-pregnant women aged 15-49 years in a union were included in the analysis. The mean age was 34.2(±7.97) years, 53.6% received at least secondary education, 87.7% were employed, and 76.5% received family planning information within the last 12 months. The prevalence of modern contraceptive use was 24.8% (95% CI: 22.9-26.7). Women's autonomy was independently associated with modern contraceptive use. Compared with women with low autonomy, women with moderate (AOR= 1.26, 95% CI: 1.02-1.55, p = 0.034) and high autonomy (AOR = 1.34, 95% CI: 1.01-1.79, p = 0.044) had increased odds of modern contraceptive use. Maternal age, education, number of living children, employment, region, and exposure to family planning information were also strongly associated with modern contraceptive use. CONCLUSIONS: The findings from this study support the assertion that women's autonomy may be vital in promoting the use of modern contraceptives among women in a union in Ghana and other low-income and middle-income countries and should be considered in family planning programs.

Contraceptive use among women with a history of induced abortion: findings from a national sample of sexually active, non-pregnant women in Ghana.

OBJECTIVE: The aim of the study was to examine the relationship between a history of induced abortion and current use of contraception among reproductive-aged women in Ghana. METHODS: The analysed data were a weighted sample of 6544 sexually active, non-pregnant women aged 15-49 years, obtained from the 2014 Ghana Demographic and Health Survey. Survey logistic regression analysis was used to estimate the odds of currently using any contraception and of using a modern method of contraception, given a history of induced abortion in the period 2009-2014. RESULTS: A history of induced abortion between 2009 and 2014 was reported by 17.4% of women (95% CI 16.0%, 18.9%); 28.7% (95% CI 26.9%, 30.6%) were currently using a method of contraception and 23.0% (95% CI 21.4%, 24.7%) were currently using a modern method of contraception. The majority (80.1%) of current contraceptive users were using a modern method. The adjusted analysis revealed no statistically significant association between a history of induced abortion and current contraceptive behaviour. Other factors were associated with modern contraceptive use. CONCLUSION: Overall, the use of contraception among sexually active women in Ghana was found to be low. Our findings showed that women's experience of induced abortion was unlikely to influence their current use of modern contraception.

Trend of tuberculosis case notifications and their determinants in Africa and South-East Asia during 2000-2018: a longitudinal analysis of national data from 58 countries.

Background: The World Health Organization (WHO) regions of Africa and South-East Asia are the epicentres of the global tuberculosis (TB) epidemic. This study aimed at examining the trend and determinants of TB case notifications in the two regions during 2000-2018.Methods: This was a retrospective analysis of yearly, new TB cases notified to the WHO. We obtained data on potential determinants for the 58 countries in the two regions during 2000-2018. Multivariable longitudinal fixed-effects regression analysis was used to quantify the association between the determinants and TB notifications.Results: During 2000-2018, TB notifications and incidence declined in Africa. In South-East Asia, case notifications increased while the incidence declined, on average, by 2% per year during the same period. After controlling for health, socioeconomic indicators, country and year fixed-effects, each 1% increase in the antiretroviral therapy (ART) coverage and the TB treatment success was associated with a decrease per 100,000 population in the TB case notification rate of -1.62 (95% CI: -4.93, -1.90; p = .037) and -0.91(95% CI: -1.54, -0.28; p = .005) respectively. Similarly, each 1-year increase in the life expectancy at birth resulted in a decrease in TB case notification rates of -6.64 (95% CI: -12.32, -0.95; p = .037). By contrast, a 1% increase in the unemployment rate resulted in an increase in TB notification rate of 3.49 cases (95% CI: 0.19, 6.79; p = .039).Conclusion: Improving population health and the broad scale-up of ART coverage could complement existing TB treatment coverage and cure programmes to drive down new cases in Africa and South-East Asia.

"I couldn't buy the items so I didn't go to deliver at the health facility" Home delivery among rural women in northern Ghana: A mixed-method analysis.

BACKGROUND: Maternal mortality remains a major challenge to health systems in low and middle-incoming countries. Some pregnant women develop potentially life-threatening complications during childbirth. Therefore, home delivery is a precursor for maternal mortality. In this study, we aimed at not only estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we also explored the reasons for home delivery among women in rural Ghana. METHODS: The study was conducted among mothers with delivery experience in selected communities in the Builsa South district located in the Upper East Region of Ghana. Both quantitative and qualitative data were collected using semi-structured questionnaires and Focus Group Discussion (FGD) guide respectively. A total of 456 mothers participated in this study. Regression models were used in the quantitative analysis whereas a thematic analysis approach was used to analyze the qualitative data. RESULTS: Of the 423 mothers in the quantitative research, 38.1% (95% CI: 33.5-42.8) delivered their index child at home. In adjusted analysis, women who were not exposed to information (AOR = 13.64, p<0.001) and women with 2 (AOR = 4.64, p = 0.014), 3 (AOR = 4.96, p = 0.025) or at least 4 living children (AOR = 9.59, p = 0.001) had higher odds of delivering at home. From the qualitative analysis, the poor attitude of nurses (midwives), lack of, and cost of transportation, cost of delivery kits, and traditional beliefs and practices were cited as reasons for home delivery. CONCLUSION: Despite the government's efforts to provide free maternal care services to women in Ghana, a significant proportion of rural women still deliver at home due to other 'hidden costs'. Addressing poor staff attitude, transportation challenges, and negative traditional beliefs and practices through awareness creation may contribute to improving health facility delivery by rural pregnant women in Ghana.

Geo-visual integration of health outcomes and risk factors using excess risk and conditioned choropleth maps: a case study of malaria incidence and sociodemographic determinants in Ghana.

BACKGROUND: Recently, exploratory spatial data analysis is for problem solving, hypothesis generation and knowledge construction. Unless geographically weighted regression, sophisticated spatial regression models best control spatial heterogeneity in outcomes and the associated risk factors but cannot visually display and identify areas of the significant associations. The under-utilised excess risk maps (ERMs) and conditioned choropleth maps (CCMs) are useful to address this issue and simplify epidemiological information to public health stakeholders without much statistical backgrounds. Using malaria and sociodemographic determinants in Ghana as case study, this paper applied ERM and CCM techniques for identification of areas at elevated risk of disease-risk factor co-location. METHOD: We computed and smoothed mean district-specific malaria incidences for the period 2010 to 2014 as a function of sociodemographic determinants. The spatial distribution of malaria was investigated through global and local spatial autocorrelations, and the association with sociodemographic risk factors evaluated with bivariate correlations. ERMs and CCMs were produced for the statistically significant risk factors. RESULTS: The incidence of malaria increased over time with cluster locations detected, predominantly at the northern parts but later few spread to the middle parts of the country. Our results suggested that with respect to sociodemographic determinants, district variations in malaria rates might be explained by inequalities in seven sociodemographics, including an unexpected significant negative association with non-religious affiliation. The sociodemographics had positive spatial autocorrelations, exhibited statistically significant interactions and the strongest was observed in urbanisation-basic education correlation (p< 0.01, r = +0.969). The ERMs and CCMs specifically identified locations with lower or higher than expected rates with respect to particular risk factor(s) where improving risk factor(s) such as employment-to-population ratio in rural areas, basic education could have cascade effects to reduce the expected malaria incidence in endemic areas. CONCLUSION: Ghana remains malaria hyperendemic region with district-level spatial heterogeneity. Significant association between malaria and sociodemographics was detected and the ERMs and CCMs geo-visually pinpointed locations of these significant associations. To complement sophisticated spatial regression models, the easily interpretable ERMs and CCMs could be used to specify where disease-risk factor associations are significant, simplifying complex spatial epidemiological information for efficient public health administration.